PAIN TREATMENT TECHNIQUES
Our treatment techniques offer a pain free window for clients, allowing them to become more active and engage fully in their physiotherapy based rehabilitation and return to work programmes.
We focus on:
- Reducing the pain to an acceptable level.
- Addressing the psychological problems including anxiety and depression, coping mechanisms.
- Improving patient / family / workplace education and attitudes to the pain and its management ( by support and education).
- Addressing all three treatment areas together will give the best results.
Non-Surgical
1. Physical Therapy:
- To reduce muscle pain/tension.
- To mobilize painful joints.
- To strengthen muscles.
- To encourage a return to optimal daily function.
2. Western acupuncture – dry needling
- Good evidence for widespread pain, knee pain and fibromyalgia
- Different from TCM Chinese sinseh acupuncture.
The World Health Organisation has specific recommendations for certain pain conditions. Scientific evidence explain how acupuncture works. This is different from traditional Chinese medicine. 
The treatment consists of inserting needles to stimulate nerves in skin and muscle. No drugs are injected through the needles. Needles may be placed in tender areas of muscle or joints. It is most commonly used to treat:
- pain in the muscles or joints for example back, neck and chest pain.
- headaches, migraine, nerve pain.
- fibromyalgia (widespread muscle pain).
3. Trigger point injections – local anaesthetic and steroids to break the pain cycle
4. Infusions – Lidocaine, Ketamine
- Using local anaesthetic and other types of stronger medications under hospital supervision and infusing it directly into the vein is one method that can be effective.
- It can provide 3-6 months pain relief and reduction in some patients.
Pharmocologic Treatment
We may prescribe opioids (narcotics) for pain management as evidenced by National Institute of Clinical Excellence guidelines.
Spinal Injections and Minimally Invasive Treatment
- Facet blocks
- Transforaminal epidural steroid injections
- Selective nerve blocks
- Pulsed radiofrequency dennervation
- Joint injections:
- Shoulder/elbow/ wrist
- Hip/knee/ankle
Local anaesthetic and steroids are injected around the nerve (nerve root blocks, epidurals) where they exit or around identified pain sites (facets, joints). These can be to initially reduce the pain due to any residual inflammation and to ‘reset’ the pain sensations. If there is any benefit from these short acting procedures, longer lasting benefit can be produced from using a pulsed dennervation technique. Pulsed dennervation: This is a non-destructive technique that uses very tiny pulses of electricity delivered close to the nerve through a special needle that alters the chemicals within the nerve that process painful sensations.
Neuromodulation
- Peripheral Neuromodulation – Percutaneous external Neuromodulation (PENS)
- Easy, 20-30mins application, no injections, low current therapy
- Spinal cord stimulation (SCS)
- More complex, requires surgical access
Treatment of pain can be via stimulation of peripheral nerves (PENS) or spinal cord (SCS). A spinal cord stimulator is a device used to send electrical signals to the spinal cord to control chronic pain. It is not a simple procedure and is used in very complex pains that do not respond to other conservative measures.
Find out more about PENS treatment here.
Implantable Pain Pumps - Intrathecal Drug Delivery System
- Infusion devices that can be attached to a pump.
- Implanted into your body or used externally to deliver medications directly to the spinal area (intrathecal).
- Useful in patients who cannot tolerate oral medications due to extreme side effects.
- It gives smoother drug control with minimal side effects particularly in palliative conditions.
It is one of the options for terminally ill cancer patients to have a better quality of life in order to remain mobile.